Description
Introduction: Health challenges among Nepalese labor migrants (NLMs) working internationally are a growing concern, with mental health issues, accidents, injuries, and infectious diseases being predominant. Additionally, the lack of comprehensive health information on NLMs poses significant challenges in addressing these issues effectively. This combined scoping review and qualitative study aimed to assess NLMs' health problems and the management of their health information.
Method: The scoping review followed the six-stage process by Arksey and O'Malley, identifying 16 relevant studies out of 455, emphasizing mental health problems, accidents, injuries, and infectious diseases among NLMs. Selected studies were those: (i) conducted between January 2000 and July 2020; (ii) related to NLMs; and (iii) assessed or analyzed any health issues of NLMs. We excluded review studies and studies on internal LMs. For qualitative study, stakeholders involved directly or indirectly in maintaining the health profile of NLMs were first mapped, physically visited, and any documents or information were collected. Then, sixteen key informant interviews were conducted among these stakeholders related to labor migrants' health information management and challenges. A checklist extracted information from the interviews, and a thematic analysis was carried out to summarize the challenges.
Results: The scoping review highlighted prevalent health issues among NLMs, with data from the Foreign Employment Board (FEB) indicating 7,467 deaths and 1,512 disabilities among NLMs between 2008-2018. The qualitative study found that government bodies, NGOs, and approved medical centers handle health data for NLMs. The FEB records NLM deaths and disabilities while working abroad, stored in an online portal named Foreign Employment Information Management System (FEIMS) by the Department of Foreign Employment (DoFE). Before departure, NLMs undergo mandatory health assessments at approved private medical centers. Records from these assessments start on paper and then transition to an online form stored by the DoFE. Completed paper forms are sent to District Health Offices, which then report to the Department of Health Services (DoHS), Ministry of Health and Population (MoHP), and related infectious disease centers. However, there's no formal health assessment for NLMs upon their return to Nepal. Key informants highlighted concerns about maintaining NLM health records, grouped into three themes: the lack of interest in a unified online system, the need for skilled personnel and equipment, and the creation of health indicators for migrant health assessment.
Conclusions: The findings underscore the urgency of addressing NLMs' health issues and streamlining the management of their health information. Pre-departure orientation programs should cover mental health strategies, labor rights, healthcare accessibility, and safety measures. Moreover, there is a crucial need to link pre-migration health assessments with national health systems and develop a unified migrant health information management system. Addressing these gaps is critical to effectively track, support, and improve the health outcomes of Nepalese labor migrants both abroad and upon their return.
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